实时三维超声心动图评价冠脉介入术后左室收缩功能变化

应用实时三维超声心动图评价冠心病患者经皮冠状动脉介入术(PCI)后左室收缩功能的变化。研究对象分为两组,正常组14例为冠脉造影无异常发现者,冠心病组49例行冠脉内支架治疗。所有患者均于术前及术后14天行实时三维超声检查,测得左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)及左室射血分数(LVEF)。结果,正常组术前与术后LVESV、LVEDV及LVEF差异无统计学意义;冠心病组术后LVESV、LVEDV显著小于术前(P<0.001),LVEF显著高于术前(P<0.001)。结果表明,实时三维超声心动图能准确评价左室收缩功能,冠心病患者PCI后左室收缩功能明显改善。     

Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion

Objective:The aim of this study is to investigate if dual-source computed tomography(DSCT) could guide the percutaneous coronary intervention(PCI) of chronic total occlusion(CTO).Methods:We enrolled patients who were confirmed to have at least one native coronary artery CTO by DSCT before they underwent selective PCI in the period from December 2007 to October 2008.A CTO was defined as an obstruction of a native coronary artery with no luminal continuity.The CT-guided PCI procedure involved placing CT and fluoroscopic images side-by-side on the screen.DSCT images were analyzed for location,segment,plaque characteristics,calcification,and proximal lumen diameter of the CTO before PCI.The guidewire was advanced and manipulated under CT guidance.The PCI was carried out and the results were compared.Results:Seventy-four CTOs were assessed.PCI was successful in 57 cases of CTOs(77.0%).According to the results,CTOs were divided into two groups:successful-PCI and failed-PCI.All coronary artery paths of CTOs were clearly recognized by DSCT.In the successful-PCI group,soft plaques were detected much more often than those in the failed-PCI group,but fibrous and calcified plaques were seen more often in the failed-PCI group.Calcification severity in CTO segments showed a significant difference between the groups(P=0.014).Calcified plaques were detected in 20(35.1%) lesions in the successful-PCI group.More than 70% of the failures were calcified plaques,of which there were two arc-calcified and one circular-calcified lesions.Occlusions were longer in the failed-PCI group than those in the successful-PCI group [(38.8±25.0) vs.(18.0±15.3) mm,respectively,P0.01].Fewer guidewires were used in the successful-PCI group compared with the failed-PCI group(1.7±1.0 vs.2.5±0.9,respectively,P0.01).The logistic regression analysis indicated that predictors of recanalization of CTOs included occlusion length(P=0.0035,risk ratio(RR)=0.93) and calcification severity(P=0.05,RR=0.27).Multi-linear trends analysis showed that the factors affecting procedural time were CTO location(P=0.0141) and occlusion length(P=0.0035).Conclusions:DSCT could delineate the path of CTOs and characterize plaques.The outcomes of PCI were related to thrombolysis in myocardial infarction(TIMI) flow grade,CTO characteristics,severity of calcified plaques,and the length of occlusive segments.Occlusion length and calcification severity were independent predictors of CTOs.Occlusion length and CTO segments could also help to estimate the duration of interventional procedures.     

肠淋巴液对休克大鼠心肌特性的影响

大鼠重度失血性休克30min后,左心室内压的最大上升速率( dp/dt max)和左心室收缩压(LVSP)都显著下降(P<0.01),而左心室舒张末压(LVEDP)却有所增高(P<0.05)。说明心肌的收缩功能和舒张功能均出现障碍,给少量淋巴液后(用量为0.5ml/100g体重)使休克时下降的左心室内压的最大上升速率和左心室收缩压显著回升(P<0.05),而增高的左心室舒张末压回落不明显,提示淋巴液可改善休克心肌的收缩功能障碍,但对低血容量情况下的心肌舒张功能无明显改善。     

Adiponectin levels are associated with the number and activity of circulating endothelial progenitor cells in patients with coronary artery disease

Objective: To study the relationship between plasma adiponectin concentration and the functional activities of circulating endothelial progenitor cells (EPCs) in patients with coronary artery disease (CAD). Methods: Circulating EPCs were enumerated as AC133+/KDR+ cells via flow cytometry and identified by co-staining with Dii-acLDL and fluorescein isothiocy-anate (FITC)-conjugated lectin under a fluorescent microscope. The migratory capacity of EPCs was measured by modified Boyden chamber assay. Adhesion capacity was performed to count adherent cells after replating EPCs on six-well culture dishes coated with fibronectin. Results: The number of circulating EPCs (AC133+/KDR+ cells) decreased significantly in CAD patients, compared with control subjects [(74.2±12.3) vs (83.5±12.9) cells/ml blood, P<0.0\]. In addition, the number of EPCs also decreased in CAD patients after ex vivo cultivation [(54.4±8.6) vs (71.9±11.6) EPCs/field, P<0.01]. Both circulating EPCs and differentiated EPCs were positively correlated with plasma adiponectin concentration. The functional activities of EPCs from CAD patients, such as migratory and adherent capacities, were also impaired, compared with control subjects, and positively correlated with plasma adiponectin concentration. Conclusion: The study demonstrates that the impairment of the number and functional activities of EPCs in CAD patients is correlated with their lower plasma adiponectin concentrations.     

Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

Objective

We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function.

Methods

Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit.

Results

Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%–40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold.

Conclusions

RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.     

淋巴液对不同状态大鼠左心室内压的影响

淋巴液对正常血压大鼠的平均动脉压[MAP]、左室收缩压[LVSP]及左室舒张末压[LVEDP]与生理盐水对照组各项指标相比无显著差异[P>>0.05];而对失血性休克大鼠的MAP、LVSP具有显著回升作用[P<0.01],而对休克时LVEP的恢复无明显作用[P>0.05]。提示:淋巴液只能提高休克心脏的收缩功能,在低血容量情况下对休克心脏的舒张功能无明显影响,对正常心脏的收缩和舒张功能均无明显影响。     

Application of GlycoProtein IIb/IIIa antagonist( Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese

Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty-one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then maintained at 2μg/kgmin for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 seconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the pre- and post-procedure value of PT and platelet count. KPTT was significantly higher than pre-procedure value at 2 hours after the procedure .No recurrence of angina pectoris was observed in the first nine patients within one year follow-up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPIIb/IIIa receptor antagonist (Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.     

Qualitative and quantitative analysis of goat ovaries,follicles and oocytes in view of in vitro production of embryos

Goat ovaries were collected from the slaughterhouse and categorized as right, left, corpus luteum （CL）-present and -absent group and evaluated on the basis of weight （g）, length （cm）, width （cm）, number of follicles, follicles aspirated and number and state ofcumulus-oocyte-complexes （COCs）. Comparatively higher weight [（0.66±0.02） vs （0.64±0.02） g], length [（1.17±0.02） vs （1.1 ±0.02） cm] and width [（0.77±0.02） vs （0.74±0.02） cm] were found in right ovaries than those of left. On the other hand significantly （P〈0.05） higher weight [（0.71±0.03） vs （0.64±0.01） g] and width [（0.76±0.03） vs （0.75±0.01） cm] were found in CL-present group than those of CL-absent group of ovaries. The left ovaries contained comparatively higher number of normal COCs [（1.06±0.09） per ovary] than fight ovaries [（1.03±0.10） per ovary] and the similar trend was found in total number of follicles [（4.51±0.25） vs （4.30±0.23） per ovary] and follicles aspirated [（2.55±0.14） vs （2.52±0.12） per ovary]. But the total COCs per ovary was almost similar in both ovaries [right and left： （1.85±0.12） and （1.85±0.11） per ovary, respectively]. Higher number of total COCs [（1.87±0.09） vs （1.76±0.16） per ovary], total number of follicles [（4.45±0.19） vs （4.16±0.37） per ovary], follicles aspirated [（2.55±0.10） vs （2.48±0.21） per ovary] and normal COCs [（1.12±0.07） vs （0.76±0.14） per ovary] were found in CL-absent group than those of CL-present group of ovaries.     

AMI患者PCI术后BNP相关分析及应用研究

目的:观察PCI术对AMI患者血浆中BNP的水平变化,探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对50例AMI患者PCI治疗前、治疗后7d内每日同一时间取静脉血进行BNP的测定和50例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在行PCI术后与对照组比较有显著性差异(P<0.05),PCI治疗后呈明显下降趋势.结论:AMI患者经PCI治疗血浆BNP水平变化说明PCI术对改善AMI患者的预后有重要意义.     

Temporal changes in circulating P-selectin, plasminogen activator inhibitor-1, magnesium, and creatine kinase after percutaneous coronary intervention

Objective:This study aims to determine the mechanisms underlying restenosis and ischemia-reperfusion injury of the myocardium after percutaneous coronary intervention (PCI).Methods:The present study examined serial changes (5 min,30 min,2 h,6 h,and 24 h after PCI) in circulating P-selectin,plasminogen activator inhibitor-1 (PAI-1),magnesium (Mg),and creatine kinase-myocardial band fraction (CK-MB) levels,which may be associated with restenosis and myocardial injury in patients undergoing PCI.The occurrence rates of major adverse cardiovascular events were collected over a six-month follow-up.Results:PCI induced an early elevation of P-selectin,which correlated positively with the inflation pressure used in the PCI procedure.PCI also caused a significant and sustained decrease in serum Mg in PCI patients,without an effect on PAI-1.An increase in CK-MB was observed in PCI patients,although values were within normal reference range.In addition,elevated P-selectin and decreased Mg measured shortly after the coronary angioplasty procedure were associated with recurrent treatment and heart failure,respectively.Conclusions:Our study demonstrates that PCI induces temporal changes of P-selectin,Mg,and CK-MB,which may be involved in restenosis and ischemia-reperfusion injury.These findings highlight the need for using antiplatelet therapy and Mg to reduce the risks associated with PCI.     

肾上腺素对离体豚鼠左心室流出道组织自律性电活动的影响

目的:观察肾上腺素(E)对离体豚鼠左心室流出道组织自发慢反应电位的影响.方法:采用标准玻璃微电极细胞内记录技术,观察E对离体豚鼠左心室流出道组织自发慢反应电位的影响.观测指标有:最大舒张电位(MDP),动作电位幅度(APA),0期最大除极速度(Vmax),4期自动除极速度(VDD),自发放电频率(RPF),复极50%和90%时间(APD50、APD90).结果:用100μmol/L E灌流,豚鼠左心室流出道自律组织动作电位APA明显增大(P<0.01),Vmax明显增快(P<0.05),MDP显著增大(P<0.05),APD90显著缩短(P<0.01);RPF明显增快(P<0.01),VDD明显加快(P<0.05).结论:E对左心室流出道组织自律细胞有兴奋作用.     

AMI患者PCI术对血浆BNP水平变化的初步临床观察

目的:观察PCI术对AMI患者血浆中BNP的水平变化,初步探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对20例AMI患者PCI治疗前后和20例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在AMI患者PCI术与对照组比较有显著性差异(P＜0.05),PCI治疗后呈明显下降趋势.结论:AMI患者PCI治疗血浆BNP水平变化说明PCI术能对改善AMI患者的预后有重要意义.     

Study on the serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) in patients with Helicobacter pylori Infection

Objective: To evaluate the interaction between serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) and Helicobacter pylori (H. pylori) infection in patients with chronic gastritis and peptic ulcer. Methods: The serum levels of sICAM-1 in 205 patients with chronic gastric diseases were detected by ELISA method and the status of H. pylori was determined by histologic examination, RUT, 14C - UBT, and serology. The sera obtained from 18 healthy volunteers served as controls. Results: The serum levels of sICAM-1 were significantly higher in patients with H. pylori positive than those of H. pylori negative (889.43±32.52 ng/ml vs. 747.07±30.45 ng/ml, P<0.05). The serum levels of sICAM-1 in patients with mild, moderate and severe infection of H. pylori were 841.68±72.36 ng/ml, 905.43±37.59 ng/ml and 1012.54±49.34 ng/ml,respectively (P<0.05). The serum levels of sICAM-1 proved to be significantly correlated with the density of H. pylori colonization in gastric mucosa (rs =0.316, P<0.001). The serum levels of sICAM-1 in patients with chronic gastritis and peptic ulcer were significantly higher than those in healthy controls (P<0.05). Conclusions: These results indicated that H. pylori infection up-regulates the expression of sICAM-1.     

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.     

单心动周期三维超声评价心梗后的左心收缩功能及同步性

目的应用单心动周期三维超声评价心肌梗塞患者的左心收缩功能及同步性,以便方便、快捷、准确地识别心肌梗塞的节段。方法正常组30例,心梗组27例,先用二维Simpson’S法测定左室整体EF值,再用单心动周期三维超声测左室整体EF值、SDll7值、DDI17值及各节段的容积时间曲线、EF值曲线。比较各组间参数的差异及相关性。结果正常组2D法和4D法测得的左室射血分数无明显差异。心梗组2D法和4D法测得的左室射血分数差异显著。正常组和心梗组的SD117值差异显著,DDI17值在两组间无明显差异。结论单心动周期三维超声心动图能全面真实地显示左室的几何形态,本研究显示心梗后左室整体EF值下降,17节段容积一时间曲线同步性差,曲线图直观明了,可以方便、快捷、准确地识别心肌梗塞的节段。     

A correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention

Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI, and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cardiac troponins (cTns), cTnI and cTnT, at baseline and on at least one occasion 18–24 h after PCI were measured. We also recorded serum levels of creatinine (SCr) and the urine albumin:creatinine ratio (ACR) before coronary angiography, and 24–48 h and 48–72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% (53/327) of subjects with cTns levels >99th to 599th percentile upper reference limit (URL). Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR: 3.31; 95% CI: 1.26–8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN (OR: 2.38; 95% CI: 0.88–6.46, P=0.09). We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.     

Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction

Objective: Myocardial infarction (MI) is the main cause of heart failure, but the relationship between the extent of MI and cardiac function has not been clearly determined. The present study was undertaken to investigate early changes in the electrocardiogram associated with infarct size and cardiac function after MI. Methods: MI was induced by ligating the left anterior descending coronary artery in rats. Electrocardiograms, echocardiographs and hemodynamic parameters were assessed and myocardial infarct size was measured from mid-transverse sections stained with Masson's trichrome. Results: The sum of pathological Q wave amplitudes was strongly correlated with myocardial infarct size (r = 0.920, P < 0.0001), left ventricular ejection fraction (r = (0.868, P < 0.0001) and left ventricular end diastolic pressure (r = 0.835, P < 0.0004). Furthermore, there was close relationship between MI size and cardiac function as assessed by left ventricular ejection fraction (r = (0.913, P < 0.0001) and left ventricular end diastolic pressure (r = 0.893, P < 0.0001). Conclusion: The sum of pathological Q wave amplitudes after MI can be used to estimate the extent of MI as well as cardiac function.     

Low‐intensity pulsed ultrasound ameliorates angiotensin II-induced cardiac fibrosis by alleviating inflammation via a caveolin-1-dependent pathway

ObjectiveCardiac hypertrophy and fibrosis are major pathological manifestations observed in left ventricular remodeling induced by angiotensin II (AngII). Low-intensity pulsed ultrasound (LIPUS) has been reported to ameliorate cardiac dysfunction and myocardial fibrosis in myocardial infarction (MI) through mechano-transduction and its downstream pathways. In this study, we aimed to investigate whether LIPUS could exert a protective effect by ameliorating AngII-induced cardiac hypertrophy and fibrosis and if so, to further elucidate the underlying molecular mechanisms.MethodsWe used AngII to mimic animal and cell culture models of cardiac hypertrophy and fibrosis. LIPUS irradiation was applied in vivo for 20 min every 2 d from one week before mini-pump implantation to four weeks after mini-pump implantation, and in vitro for 20 min on each of two occasions 6 h apart. Cardiac hypertrophy and fibrosis levels were then evaluated by echocardiographic, histopathological, and molecular biological methods.ResultsOur results showed that LIPUS could ameliorate left ventricular remodeling in vivo and cardiac fibrosis in vitro by reducing AngII-induced release of inflammatory cytokines, but the protective effects on cardiac hypertrophy were limited in vitro. Given that LIPUS increased the expression of caveolin-1 in response to mechanical stimulation, we inhibited caveolin-1 activity with pyrazolopyrimidine 2 (pp2) in vivo and in vitro. LIPUS-induced downregulation of inflammation was reversed and the anti-fibrotic effects of LIPUS were absent.ConclusionsThese results indicated that LIPUS could ameliorate AngII-induced cardiac fibrosis by alleviating inflammation via a caveolin-1-dependent pathway, providing new insights for the development of novel therapeutic apparatus in clinical practice.     

Tei指数评价原发性高血压患者左室功能障碍的临床研究

目的：探讨Tei指数原发性高血压患者心脏功能的临床应用价值。方法：原发性高血压患者176例．按Ganau分类法将原发性高血压分为4型；正常构型（A组，46例）、向心性重构（B组，53例）、向心性肥厚（C组，40例）、离心性肥厚（D组，37例）；正常对照组35例。以常规超声心动图检查测量舒张末期室间隔、左室后壁厚度及左室内径（IVS、LVPW、LVDed），二尖瓣血流频谱图舒张早期与舒张晚期血流峰值比（E／A），左室射血分数（EF）及Tei指数，进行对比分析。结果：1.一般资料的比较：各组同年龄、性别差异均无显著性意义，C、D组病程有显著性差异，C、D组收缩压最高（P〈0．05），B、C、D组脉压最高（P〈0．05）；2．各组超声心动图结构参数比较：C组、D组LA最大（P〈0．05）；B组LVDS最小（P〈0．05），D组LVDS最大（P〈0．05）；C组IVS、LVPW最厚（P〈0．05）；B组、D组IVS、LVPW轻度增厚（P〈0．05）；C组RWT明显厚于其它各组（P〈0．01）；C组、D组LVMI质量显著增加（P〈0.01），但C组、D组之间无统计学意义；3．各组超声心动图功能参数比较：高血压各组的E／A值均减低（P〈0．05），EF只有D组与对照组比较有显著性意义；高血压各组Tei指数均较对照组增加，呈递增趋势，各组间有显著性意义。结论：Tei指数可以客观、真实的评价高血压患者不同左室构型的心功能情况，对于评估疾病的治疗效果和预后具有很高的临床应用价值。